The Crying Game

It happened. I made a patient cry today. In fact, always the over-achiever, I made a patient and her mother cry.

It is my nightmare to tell a patient that they are overweight. I know that they know they are overweight. It's my assumption that most people don't want to be overweight. It would be easier for me to tell my grandma that she had herpes. That is how little I want to discuss weight.

Even as I shoveled lobster tail, filet mignon, cosmopolitans and more cosmopolitans into my trap this weekend, I was hoping to fit into my cute skinny pants at work this week, to say nothing of the tight-ass airplane seat. Fuck coach.

Anywho, it's my further assumption that there are exceedingly few adolescent girls who want to be overweight. Today, one happened to cross my path. She was sweet, middle school aged, 182 pounds, hypertensive and sporting a smooth, velvety acanthosis nigricans necklace.

And I had to tell her that her weight was the problem, that it was hurting her and that it would continue to hurt her if we didn't make changes. Of course, I explained why excess cardiac strain is dangerous and why diabetes is a serious illness. I told her how I could help her and how she could help herself. I never said "fat," but I cannot believe that she didn't hear that vicious, devastating word.

I told her no more Hot Cheetos, no more pan dulce, no more soda, no more unhealthy foods. I told her mom that she must not have that shit in the house (not verbatim).

And even though I told this girl that I was there to help her, that I wasn't telling her that she was bad and that I absolutely knew how much it sucked to have this conversation, I felt like a complete jackhole. And through it all, I knew that it was utterly incumbent upon me to tell her these difficult things. I'll see her in 2 weeks, food diary in hand.

Here is how research methods came in handy during this interaction. I utilized a verbal Likert Scale in the form of: On a scale of 1 to 10, how much do you hate me right now? She smiled.